			<script type="text/javascript">
				function verifform()
				{
					var erreur = false;
					
					var firstname = $('#firstname').val();
					var surname = $('#surname').val();
					var address = $('#address').val();
					var zip = $('#zip').val();
					var city = $('#city').val();
					var country = $('#country').val();
					var email = $('#email').val();
					var jour = $('#jour').val();
					var mois = $('#mois').val();
					var annee = $('#annee').val();
					document.getElementById('birthdate').value = jour + '/' + mois + '/' + annee;
					var birthdate = $('#birthdate').val();
					var accept = $('#hid_accept').val();
					
					if (firstname.length < 1)
					{
						erreur = true;
						document.getElementById('span_firstname').style.color = '#c9070e';
					}
					else
						document.getElementById('span_firstname').style.color = '#000';
					
					if (surname.length < 1)
					{
						erreur = true;
						document.getElementById('span_surname').style.color = '#c9070e';
					}
					else
						document.getElementById('span_surname').style.color = '#000';
					
					if (address.length < 1)
					{
						erreur = true;
						document.getElementById('span_address').style.color = '#c9070e';
					}
					else
						document.getElementById('span_address').style.color = '#000';
					
					if (zip.length < 1)
					{
						erreur = true;
						document.getElementById('span_zip').style.color = '#c9070e';
					}
					else
						document.getElementById('span_zip').style.color = '#000';
					
					if (city.length < 1)
					{
						erreur = true;
						document.getElementById('span_city').style.color = '#c9070e';
					}
					else
						document.getElementById('span_city').style.color = '#000';
					
					if (country == '{{=trad('Choose', APPLNG)}}')
					{
						erreur = true;
						document.getElementById('span_country').style.color = '#c9070e';
					}
					else
						document.getElementById('span_country').style.color = '#000';
					
					if (email.length < 1)
					{
						erreur = true;
						document.getElementById('span_email').style.color = '#c9070e';
					}
					else
						document.getElementById('span_email').style.color = '#000';
					
					if (birthdate.length < 1)
					{
						erreur = true;
						document.getElementById('span_birthdate').style.color = '#c9070e';
					}
					else
						document.getElementById('span_birthdate').style.color = '#000';
					
					if (accept != 'yes')
					{
						erreur = true;
						document.getElementById('tdcheckbox').style.backgroundColor = '#FDC8C9';
						document.getElementById('span_accept').style.color = '#c9070e';
					}
					else
					{
						document.getElementById('tdcheckbox').style.backgroundColor = '#ffffff';
						document.getElementById('span_accept').style.color = '#000';
					}
					
					if (!erreur)
					{
						if (!email.match("^[A-Za-z0-9](([_\.\-]?[a-zA-Z0-9]+)*)@([A-Za-z0-9]+)(([\.\-]?[a-zA-Z0-9]+)*)\.([A-Za-z]{2,})$"))
						{
							erreur = true;
							document.getElementById('span_email').style.color = '#c9070e';
							alert("{{=trad('Invalid email', APPLNG)}}");
						}
						else
							document.getElementById('span_email').style.color = '#000';
							
						if(!birthdate.match("^[0-9]{2}/[0-9]{2}/[0-9]{4}$"))
						{
							erreur = true;
							document.getElementById('span_birthdate').style.color = '#c9070e';
							alert("{{=trad('Invalid date of birth. Please use this format dd/mm/yyyy', APPLNG)}}");
						}
						else
							document.getElementById('span_birthdate').style.color = '#000';
					}
					
					if (!erreur)
					{
						var tabnaissance = birthdate.split('/');
						var jour = tabnaissance[0];
						var mois = tabnaissance[1];
						var annee = tabnaissance[2];
						if (annee > {{=date('Y')}})
						{
							erreur = true;
							document.getElementById('span_birthdate').style.color = '#c9070e';
							alert("{{=trad('Thanks to choose a valid year please.', APPLNG)}}");
						}
						else
							document.getElementById('span_birthdate').style.color = '#000';
						if (mois > 12)
						{
							erreur = true;
							document.getElementById('span_birthdate').style.color = '#c9070e';
							alert("{{=trad('Thanks to choose a valid month please.', APPLNG)}}");
						}
						else
							document.getElementById('span_birthdate').style.color = '#000';
						if (mois < 1)
						{
							erreur = true;
							document.getElementById('span_birthdate').style.color = '#c9070e';
							alert("{{=trad('Thanks to choose a valid month please.', APPLNG)}}");
						}
						else
							document.getElementById('span_birthdate').style.color = '#000';
						if (jour > 31)
						{
							erreur = true;
							document.getElementById('span_birthdate').style.color = '#c9070e';
							alert("{{=trad('Thanks to choose a valid day please.', APPLNG)}}");
						}
						else
							document.getElementById('span_birthdate').style.color = '#000';
						if (jour < 1)
						{
							erreur = true;
							document.getElementById('span_birthdate').style.color = '#c9070e';
							alert("{{=trad('Thanks to choose a valid day please.', APPLNG)}}");
						}
						else
							document.getElementById('span_birthdate').style.color = '#000';
						if (mois == '02' && jour > 28)
						{
							if (jour == 29)
							{
								if(annee % 400 == 0 || (annee % 4 == 0 && annee % 100 != 0))
									document.getElementById('span_birthdate').style.color = '#000';
								else
								{
									erreur = true;
									document.getElementById('span_birthdate').style.color = '#c9070e';
									alert(annee + " {{=trad('is not a leap year. Please correct your date of birth.', APPLNG)}}");
								}
							}
							else
							{
								erreur = true;
								document.getElementById('span_birthdate').style.color = '#c9070e';
								alert("{{=trad('Februar has 29 days in maximum. Please correct your date of birth.', APPLNG)}}");
							}
						}
						if (mois == '04' || mois == '06' || mois == '09' || mois == '11')
						{
							if (jour > 30)
							{
								erreur = true;
								document.getElementById('span_birthdate').style.color = '#c9070e';
								alert("{{=trad('This month does not contain 31 days. Please correct your date of birth.', APPLNG)}}");
							}
						}
					}
					
					if (erreur == true)
						$('#error_form').show();
					else
						$('#formmailinglist').submit();
				}
				
				function change_accept()
				{
					var old = $('#hid_accept').val();
					if (old == 'yes')
						document.getElementById('hid_accept').value = 'no';
					else
						document.getElementById('hid_accept').value = 'yes';
				}
			</script>
			<div id="parfums_left_b_form">
				<br />
				Comme des Garçons parfums<br />
				Mailing List 
			</div>
			<div id="parfums_right_h1_form">
				<h1>Mailing List</h1>
			</div>
			<div class="clear15">&nbsp;</div>
			<div id="parfums_left_form">
				<p>{{=trad('If you would like to join the Comme des Garçons mailing list, please fill in  the form with the necessary details. All information you provide will be treated in the strictest confidence.', APPLNG);}}</p>
				<br />
			</div>
			<div id="parfums_right_form">
				<p>
					<form action="{{=URL_SITE}}" id="formmailinglist" method="post">
					<fieldset style="border: none;">
					{{=form_hidden('action_form', 1)}}
					{{=form_hidden(NOMPAGE, $this -> page)}}
					<input type="hidden" id="hid_accept" name="hid_accept" value="yes" />
					<table style="border: solid 0px #fff; background-color:#fff;" width="445" cellpadding="0" cellspacing="0">
						<tr>
							<td align="left"><span id="span_firstname">{{=trad('First Name', APPLNG)}}</span></td>
							<td><input name="firstname" id="firstname" class="input" type="text" size="50" tabindex="1" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_surname">{{=trad('Surname', APPLNG)}}</span></td>
							<td><input name="surname" id="surname" class="input" type="text" size="50" tabindex="2" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_address">{{=trad('Address', APPLNG)}}</span></td>
							<td><input maxlength="30" name="address" id="address" class="input" type="text" size="50" tabindex="3" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_address">{{=trad('Address 2', APPLNG)}}</span></td>
							<td><input maxlength="30" name="address_2" id="address_2" class="input" type="text" size="50" tabindex="4" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_zip">{{=trad('Postcode', APPLNG)}}</span></td>
							<td><input name="zip" id="zip" class="input" type="text" size="50" tabindex="5" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_city">{{=trad('City', APPLNG)}}</span></td>
							<td><input name="city" id="city" class="input" type="text" size="50" tabindex="6" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_country">{{=trad('Country', APPLNG)}}</span></td>
							<td>
							<select class="select" id="country" name="country" tabindex="7">
								<option>{{=_t('Choose', APPLNG)}}</option>
								<option value="af">Afghanistan</option><option value="ax">Aland Islands</option><option value="al">Albania</option><option value="dz">Algeria</option><option value="as">American Samoa</option><option value="ad">Andorra</option><option value="ao">Angola</option><option value="ai">Anguilla</option><option value="aq">Antarctica</option><option value="ag">Antigua and Barbuda</option><option value="ar">Argentina</option><option value="am">Armenia</option><option value="aw">Aruba</option><option value="au">Australia</option><option value="at">Austria</option><option value="az">Azerbaijan</option><option value="bs">Bahamas</option><option value="bh">Bahrain</option><option value="bd">Bangladesh</option><option value="bb">Barbados</option><option value="by">Belarus</option><option value="be">Belgium</option><option value="bz">Belize</option><option value="bj">Benin</option><option value="bm">Bermuda</option><option value="bt">Bhutan</option><option value="bo">Bolivia</option><option value="ba">Bosnia and Herzegovina</option><option value="bw">Botswana</option><option value="bv">Bouvet Island</option><option value="br">Brazil</option><option value="io">British Indian Ocean Territory</option><option value="vg">British Virgin Islands</option><option value="bn">Brunei</option><option value="bg">Bulgaria</option><option value="bf">Burkina Faso</option><option value="bi">Burundi</option><option value="kh">Cambodia</option><option value="cm">Cameroon</option><option value="ca">Canada</option><option value="cv">Cape Verde</option><option value="ky">Cayman Islands</option><option value="cf">Central African Republic</option><option value="td">Chad</option><option value="cl">Chile</option><option value="cn">China</option><option value="cx">Christmas Island</option><option value="cc">Cocos (Keeling) Islands</option><option value="co">Colombia</option><option value="km">Comoros</option><option value="cg">Congo</option><option value="ck">Cook Islands</option><option value="cr">Costa Rica</option><option value="hr">Croatia</option><option value="cu">Cuba</option><option value="cy">Cyprus</option><option value="cz">Czech Republic</option><option value="cd">Democratic Republic of Congo</option><option value="dk">Denmark</option><option value="xx">Disputed Territory</option><option value="dj">Djibouti</option><option value="dm">Dominica</option><option value="do">Dominican Republic</option><option value="tl">East Timor</option><option value="ec">Ecuador</option><option value="eg">Egypt</option><option value="sv">El Salvador</option><option value="gq">Equatorial Guinea</option><option value="er">Eritrea</option><option value="ee">Estonia</option><option value="et">Ethiopia</option><option value="fk">Falkland Islands</option><option value="fo">Faroe Islands</option><option value="fm">Federated States of Micronesia</option><option value="fj">Fiji</option><option value="fi">Finland</option><option value="fr">France</option><option value="gf">French Guyana</option><option value="pf">French Polynesia</option><option value="tf">French Southern Territories</option><option value="ga">Gabon</option><option value="gm">Gambia</option><option value="ge">Georgia</option><option value="de">Germany</option><option value="gh">Ghana</option><option value="gi">Gibraltar</option><option value="gr">Greece</option><option value="gl">Greenland</option><option value="gd">Grenada</option><option value="gp">Guadeloupe</option><option value="gu">Guam</option><option value="gt">Guatemala</option><option value="gn">Guinea</option><option value="gw">Guinea-Bissau</option><option value="gy">Guyana</option><option value="ht">Haiti</option><option value="hm">Heard Island and Mcdonald Islands</option><option value="hn">Honduras</option><option value="hk">Hong Kong</option><option value="hu">Hungary</option><option value="is">Iceland</option><option value="in">India</option><option value="id">Indonesia</option><option value="ir">Iran</option><option value="iq">Iraq</option><option value="xe">Iraq-Saudi Arabia Neutral Zone</option><option value="ie">Ireland</option><option value="il">Israel</option><option value="it">Italy</option><option value="ci">Ivory Coast</option><option value="jm">Jamaica</option><option value="jp">Japan</option><option value="jo">Jordan</option><option value="kz">Kazakhstan</option><option value="ke">Kenya</option><option value="ki">Kiribati</option><option value="kw">Kuwait</option><option value="kg">Kyrgyzstan</option><option value="la">Laos</option><option value="lv">Latvia</option><option value="lb">Lebanon</option><option value="ls">Lesotho</option><option value="lr">Liberia</option><option value="ly">Libya</option><option value="li">Liechtenstein</option><option value="lt">Lithuania</option><option value="lu">Luxembourg</option><option value="mo">Macau</option><option value="mk">Macedonia</option><option value="mg">Madagascar</option><option value="mw">Malawi</option><option value="my">Malaysia</option><option value="mv">Maldives</option><option value="ml">Mali</option><option value="mt">Malta</option><option value="mh">Marshall Islands</option><option value="mq">Martinique</option><option value="mr">Mauritania</option><option value="mu">Mauritius</option><option value="yt">Mayotte</option><option value="mx">Mexico</option><option value="md">Moldova</option><option value="mc">Monaco</option><option value="mn">Mongolia</option><option value="me">Montenegro</option><option value="ms">Montserrat</option><option value="ma">Morocco</option><option value="mz">Mozambique</option><option value="mm">Myanmar</option><option value="na">Namibia</option><option value="nr">Nauru</option><option value="np">Nepal</option><option value="an">Netherlands Antilles</option><option value="nl">Netherlands</option><option value="nc">New Caledonia</option><option value="nz">New Zealand</option><option value="ni">Nicaragua</option><option value="ne">Niger</option><option value="ng">Nigeria</option><option value="nu">Niue</option><option value="nf">Norfolk Island</option><option value="kp">North Korea</option><option value="mp">Northern Mariana Islands</option><option value="no">Norway</option><option value="om">Oman</option><option value="pk">Pakistan</option><option value="pw">Palau</option><option value="ps">Palestinian Territories</option><option value="pa">Panama</option><option value="pg">Papua New Guinea</option><option value="py">Paraguay</option><option value="pe">Peru</option><option value="ph">Philippines</option><option value="pn">Pitcairn Islands</option><option value="pl">Poland</option><option value="pt">Portugal</option><option value="pr">Puerto Rico</option><option value="qa">Qatar</option><option value="re">Reunion</option><option value="ro">Romania</option><option value="ru">Russia</option><option value="rw">Rwanda</option><option value="sh">Saint Helena and Dependencies</option><option value="kn">Saint Kitts and Nevis</option><option value="lc">Saint Lucia</option><option value="pm">Saint Pierre and Miquelon</option><option value="vc">Saint Vincent and the Grenadines</option><option value="ws">Samoa</option><option value="sm">San Marino</option><option value="st">Sao Tome and Principe</option><option value="sa">Saudi Arabia</option><option value="">Select One</option><option value="sn">Senegal</option><option value="rs">Serbia</option><option value="sc">Seychelles</option><option value="sl">Sierra Leone</option><option value="sg">Singapore</option><option value="sk">Slovakia</option><option value="si">Slovenia</option><option value="sb">Solomon Islands</option><option value="so">Somalia</option><option value="za">South Africa</option><option value="gs">South Georgia and South Sandwich Islands</option><option value="kr">South Korea</option><option value="es">Spain</option><option value="pi">Spratly Islands</option><option value="lk">Sri Lanka</option><option value="sd">Sudan</option><option value="sr">Suriname</option><option value="sj">Svalbard and Jan Mayen</option><option value="sz">Swaziland</option><option value="se">Sweden</option><option value="ch">Switzerland</option><option value="sy">Syria</option><option value="tw">Taiwan</option><option value="tj">Tajikistan</option><option value="tz">Tanzania</option><option value="th">Thailand</option><option value="tg">Togo</option><option value="tk">Tokelau</option><option value="to">Tonga</option><option value="tt">Trinidad and Tobago</option><option value="tn">Tunisia</option><option value="tr">Turkey</option><option value="tm">Turkmenistan</option><option value="tc">Turks And Caicos Islands</option><option value="tv">Tuvalu</option><option value="vi">US Virgin Islands</option><option value="ug">Uganda</option><option value="ua">Ukraine</option><option value="ae">United Arab Emirates</option><option value="uk">United Kingdom</option><option value="um">United States Minor Outlying Islands</option><option value="us">United States</option><option value="uy">Uruguay</option><option value="uz">Uzbekistan</option><option value="vu">Vanuatu</option><option value="va">Vatican City</option><option value="ve">Venezuela</option><option value="vn">Vietnam</option><option value="wf">Wallis and Futuna</option><option value="eh">Western Sahara</option><option value="ye">Yemen</option><option value="zm">Zambia</option><option value="zw">Zimbabwe</option>
							</select>
							</td>
						</tr>
						<tr>
							<td align="left"><span id="span_email">{{=trad('Email', APPLNG)}}</span></td>
							<td><input name="email" id="email" class="input" type="text" size="50" tabindex="8" /></td>
						</tr>
						<tr>
							<td align="left"><span id="span_birthdate">{{=trad('Date of Birth', APPLNG)}}</span></td>
							<td align="left" style="padding-left: 35px;">
								<input type="hidden" name="birthdate" id="birthdate" class="input" type="text" size="50" tabindex="9" />
								<select id="jour">
								{{for($i = 1 ; $i < 32 ; $i++):}}
								<option value="{{if($i < 10):}}0{{endif;}}{{=$i}}">{{if($i < 10):}}0{{endif;}}{{=$i}}</option>
								{{endfor;}}
								</select>
								&nbsp;&nbsp;
								<select id="mois">
								{{for($i = 1 ; $i < 13 ; $i++):}}
								<option value="{{if($i < 10):}}0{{endif;}}{{=$i}}">{{if($i < 10):}}0{{endif;}}{{=$i}}</option>
								{{endfor;}}
								</select>
								&nbsp;&nbsp;
								<select id="annee">
								{{for($i = date('Y') - 16 ; $i > 1899 ; $i--):}}
								<option value="{{if($i < 10):}}0{{endif;}}{{=$i}}">{{if($i < 10):}}0{{endif;}}{{=$i}}</option>
								{{endfor;}}
								</select>
							</td>
						</tr>
				
			</table>
			<table style="border: solid 0px #fff; background-color:#fff;" width="445" cellpadding="0" cellspacing="0">
				<tr>
					<td align="left">
						<p id="span_accept" class="tac">
							I hereby accept that my personal data be treated in accordance with the Spanish Data Protection Act (Ley Orgánica de Protección de Datos de carácter personal, L.O. 15/1999, de 13 de Diciembre). In agreement with the  L.O. 15/1999, I give permission for my personal data to be stored on the ANTONIO PUIG, S.A. database created for advertising and promotional purposes. I can exercise my rights of access, rectification, cancellation  and disagreement through a written request to ANTONIO PUIG, S.A. Comme des Garçons Marketing Department (Travessera de Gracia nº 9, 08021 Barcelona).
						</p>
					</td>
					<td style="width: 50px;" id="tdcheckbox">
						<input type="checkbox" id="accept" name="accept" value="yes" onclick="change_accept();" checked="checked" />
					</td>
				</tr>
				<tr>
					<td align="left">
						<br />
						&#9658;&nbsp; <a href="#" onclick="verifform(); return false;">SUBMIT</a>
						<br />
						<span id="error_form" style="color: #c9070e; display: none;">
							{{=trad('Please correct the red fields and try again.', APPLNG);}}
						</span>
					</td>
					<td>
						&nbsp;
					</td>
				</tr>
				<tr>
					<td align="left" style="text-transform: uppercase;">
						<br />
						&#9658;&nbsp; 
						<a href="{{=URL_SITE}}terms-and-conditions/">
							Terms &amp; Conditions
						</a>
					</td>
					<td>
						&nbsp;
					</td>
				</tr>
			</table>
			</fieldset>
			</form>
			</p>
			</div>
